Your treatment plan for gallstones depends on how the symptoms are affecting your daily life.
If you don't have any symptoms, a policy of 'active monitoring' is often recommended. This means you won't receive immediate treatment, but you should let your GP know if you notice any symptoms.
As a general rule, the longer you go without symptoms, the less likely it is that your condition will get worse.
You may need treatment if you have a condition that increases your risk ofdeveloping complications, such as:
Treatment may also be recommended if a scan shows high levels of calcium inside your gallbladder, as this can lead to gallbladder cancer in later life.
If you have episodes of abdominal pain (biliary colic), treatment depends on how the pain affects your daily activities. Ifthe episodes aremild and infrequent, you may be prescribed painkillers to control further episodes and given advice abouteating a healthy diet to help control the pain.
If your symptoms are more severe and occur frequently, surgery to remove the gallbladder is usually recommended.
The gallbladder isn't an essential organ andyou can lead a perfectly normal life without one.Some people may experience symptoms of bloating and diarrhoea after eating fatty or spicy food. If certain foods do trigger symptoms, you may wish to avoid them in the future.
If surgery is recommended, you'll usually have keyhole surgery to remove your gallbladder. This is known as a laparoscopic cholecystectomy.
Duringa laparoscopic cholecystectomy, three or four small cuts are made in your abdomen. One larger cut (about 2-3cm) will be by the belly button and the others (each 1cm or less) will be on the right side of your abdomen.
Your abdomen is temporarily inflated using carbon dioxide gas. This is harmless and makes it easier for the surgeon to see your organs.
A laparoscope (long thin telescope with a tiny light and video camera at the end) is inserted through one of the cuts in your abdomen. This allows your surgeon to view the operation on a video monitor.Your surgeon will then remove your gallbladder using special surgical instruments.
If it's thought there may be gallstones in the bile duct, an X-ray or ultrasound scan of the bile duct is also taken during the operation. If gallstones are found, they may be removed during keyhole surgery. If the operation can't be done this way or an unexpected complication occurs, it may have to be converted to open surgery (see below).
After the gallbladder has been removed, the gas in your abdomen escapes through the laparoscope and the cuts are closed with dissolvable stitches and covered with dressings.
Laparoscopic cholecystectomies areusually performed under a general anaesthetic , which means you'll be asleep during the procedure and won't feel any pain while it's carried out. The operation takes 60-90 minutes and you can usually go home the sameday.Full recovery typically takes around 10 days.
Single-incision laparoscopic cholecystectomy is a newer type of keyhole surgery used to remove the gallbladder. During this type of surgery, only one small cut is made, which means you'll only have onebarely visible scar.
However, single-incision laparoscopic cholecystectomies havent been carried out as often as conventional laparoscopic cholecystectomies, so there are still some uncertainties about it. Access to this type of surgery is also limited because it needs an experienced surgeon with specialist training.
The National Institute for Health and Care Excellence (NICE) has more information on single-incision laparoscopic cholecystectomy .
Alaparoscopic cholecystectomy may not always be recommended, for example if you:
In these circumstances, an open cholecystectomy may be recommended. During this procedure, a 10-15cm (4-6in) incision is made in your abdomen underneath the ribs so the gallbladder can be removed.Thisis done under general anaesthetic, so you'll be asleep and won't feel any pain.
Open surgery is just as effective as laparoscopic surgery, but it does have a longer recovery time and causes more visible scarring. Most people have to stay in hospital for up to five days and it typically takes six weeks to fully recover.
The gallbladder isn't removed during this procedure, so any stones in the gallbladder will remain unless removed using the surgical techniques mentioned above.
ERCP is similar to a diagnostic cholangiography (see diagnosing gallstones for more information), where an endoscope (long, thin flexible tube with a camera at the end) is passed through your mouth down to where the bile duct opens into the small intestine.
However, during ERCP theopening of the bile ductis widened with a small incision or an electrically heated wire. The bile duct stones are then removed or left to pass into your intestine and out of your body.
Sometimes a small tube called a stent is permanently placed in the bile duct to help the bile and stones pass.
An ERCP is usually carried out under sedation, which means you'll be awake throughout the procedure but won't experience any pain.
The ERCP procedurelasts about 30 minutes on average, but can take from 15 minutes to over an hour.You may need to stay overnight in hospital after the procedure so you can be monitored.
If yourgallstones are small and don't contain calcium, it may be possible to take ursodeoxycholic acidtablets to dissolve them.
However, these aren'tprescribed very often because:
Side effects of ursodeoxycholic acid are uncommon and are usually mild. The most commonly reported side effects are feeling sick, being sick and itchy skin.
The use of ursodeoxycholic acid isn't usually recommended for pregnant or breastfeeding women. Sexually active women should use either a barrier method of contraception, such as a condom, or a low-dose oestrogen contraceptive pill while taking ursodeoxycholic acid, as it may affect other types of oral contraceptive pills.
Ursodeoxycholic acid tablets are occasionally also prescribed as a precaution against gallstones if it's thought you're at risk of developing them. For example, you may be prescribed ursodeoxycholic acid if you've recently had weight loss surgery, as rapid weight loss can cause gallstones to grow.
Gallstones are small stones, usually made of cholesterol, that form in the gallbladder. In most cases they do not cause any symptoms and do not need to be treated.
The most common symptom of gallstones is sudden, severe abdominal pain, known as biliary colic.
Gallstones are thought to be caused by an imbalance in the chemical make-up of bile inside the gallbladder. Bile is a liquid produced by the liver to aid digestion
Gallstones are often discovered during tests for a different condition, as they often don't cause any symptoms.
The treatment plan for gallbladder conditions will depend on how the symptoms are affecting your daily life.
In a small number of people with gallstones, serious problems can develop if the gallstones cause a severe blockage or move into another part of the digestive system.